Insurance Credit Request Form - First Alert FA1220CV User Manual

OWNER'S INSURANCE PREMIUM CREDIT REQUEST
This form should be completed and forwarded to your homeowner's insurance carrier for possible premium credit.
A. GENERAL INFORMATION:
Insured's Name and Address:
Insurance Company:
FIRST ALERT PROFESSIONAL'S FA1220C ___
Type of Alarm: Burglary
Installed by:
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Central Station Name:
Address:
Phone:
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly
FA1220CV ____
Fire
Serviced by:
Name
Police Dept.
Monthly Weekly
continued on other side
Policy No.:
Other
Both
Name
Address
Fire Dept.
Other
– 55 –